Provider Demographics
NPI:1982416558
Name:POWELL, ETHAN (PTA)
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:
Last Name:POWELL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1795 DEVINNEY RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-2155
Mailing Address - Country:US
Mailing Address - Phone:803-335-0780
Mailing Address - Fax:
Practice Address - Street 1:1795 DEVINNEY RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-2155
Practice Address - Country:US
Practice Address - Phone:803-335-0780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant